Minimally invasive lateral lumbar intervertebral fusion versus traditional anterior approach for localized lumbar tuberculosis: a matched-pair case control study.

November 2, 2019

BACKGROUND CONTEXT:

Minimally invasive lateral lumbar intervertebral fusion (LLIF) procedure has been reported as a feasible alternative to the traditional anterior approach for patients with lumbar tuberculosis. However, there is still no study in the existing literature comparing LLIF to traditional surgeries in the treatment of such patients.

PURPOSE:

To evaluate the clinical, radiological, and functional outcomes of LLIF versus the traditional anterior approach for treating localized lumbar tuberculosis.

STUDY DESIGN:

Retrospective case-control study.

PATIENT SAMPLE:

A total of 60 patients with single-level localized lumbar tuberculosis.

OUTCOME MEASURES:

The outcome parameters included incision length, operation time, blood loss, complications, segmental lordosis, fusion status, Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analog scale (VAS), and Oswestry Disability Index (ODI).

METHODS:

We matched 20 patients treated by LLIF with 40 patients undergoing traditional anterior surgery (ratio, 1:2) by age, sex, lesion level, and radiographic features. The LLIF group consisted of 12 men and 8 women with a mean age of 42.2 ± 11.1 years, while the traditional group consisted of 22 men and 18 women with a mean age of 40.0 ± 14.5 years. Both the demographics and radiographic data were reviewed. Pre- and postoperative segmental lordosis Cobb angle was measured on lateral X-ray films, while fusion status was assessed on computed tomography scans. The VAS and ODI were used to evaluate functional outcomes.

RESULTS:

The average follow-up was 24 months in the LLIF group and 39 months in the traditional group. Incision length, operation time, and blood loss were significantly less in the LLIF group than in the traditional group. A similar improvement in segmental lordosis after operation was found in both groups. There was no significant difference between the two groups in neurological recovery, blood infection markers (ESR, CRP), functional outcome, or fusion rate, except for the postoperative VAS score, which was significantly lower in the LLIF group than in the traditional group (2.7 ± 1.0 vs. 3.6 ± 1.0, p = 0.003). Four patients in the traditional group received a transfusion and 4 patients had a superficial wound infection, while no patient in the LLIF group received a transfusion or experienced any infection; however, the difference between the two groups was not statistically significant (p = 0.291).

CONCLUSIONS:

Both LLIF and traditional anterior surgery are sufficient for treating patients with localized lumbar tuberculosis, but the LLIF approach results in significantly shorter operation time and less blood loss.